«dAiÀÄ£ÀUÀgÀ ²æÃPÀȵÀÚzÉêÀgÁAiÀÄ «±Àé«zÁå®AiÀÄ

VIJAYANAGARA SRI KRISHNADEVARAYA UNIVERSITY

eÁÕ£À ¸ÁUÀgÀ DªÀgÀt, «£ÁAiÀÄPÀ £ÀUÀgÀ PÀAmÉÆãÉäAmï, §¼Áîj-583 105.
Jnanasagara campus, Vinayaka nagara, Cantonment, BALLARI.-583 105.
___________________________________________________________________________________

Cfð £ÀªÀÄÆ£É/APPLICATION FORM

2019-20£Éà ±ÉÊPÀëtÂPÀ ªÀµð
À zÀ ¸ÁßvÀPÉÆÃvÀÛgÀ ¥Àz«
À /r¥ÉÆèêÀiÁ PÉÆùð£À ¥Àª
æ ÉñÀPÁÌV Cfð
For Admission to POSTGRADUATE DEGREE/DIPLOMA COURSE 2019-20
(Read the instructions in the last page carefully before filling the form) (Tick  the relevant box and use capital letters only)

PÁAiÀiÁð®AiÀÄzÀ Cfð ±ÀÄ®Ì

G¥ÀAiÉÆÃUÀPÁÌV ¥Àwæ ±ÀvÀ CAPÀUÀ¼ÀÄ Application fees
PÀæ.¸ÀA / ¥ÀæªÀUÀð GM/Other Category-
ªÀiÁvÀæ % of Marks Rs.100/-
Sl. No. /Category
FOR OFFICE SC/ST/Cat-I Rs. 50/-
USE ONLY

¥ÀæªÉñÀ §AiÀĸÀĪÀ «¨sÁUÀ/«µÀAiÀÄ

Subject/Department for which Admission Sought ______________________________

1. C¨sÀåyðAiÀÄ ºÉ¸ÀgÀÄ: ……………………………………………………………………….

Name of the Applicant Affix
In Block letters : recent
(As recorded in Degree Marks Card) passport
size
photograph
2. vÀAzÉAiÀÄ /¥ÉÇõÀPÀgÀ ºÉ¸ÀgÀÄ
EwÛÃa£À ¥Á¸ï¥ÉÆÃmïð
Father’s /Guardian’s Name C¼ÀvÉAiÀÄ ¨sÁªÀavÀæ CAn¸ÀĪÀÅzÀÄ

Day Month year

3. d£Àä ¸ÀܼÀ ªÀÄvÀÄÛ ¢£ÁAPÀ
Place and Date of Birth

4. gÁ¶ÖçÃAiÀÄvÉ/
Nationality
 5. °AUÀ / Gender UÀAqÀÄ / Male ºÉtÄÚ / Female °AUÀvÀé C®à¸ÀASÁåvÀgÀÄ/ Transgender

¥Àæ.ªÀUÀð-
6. ªÀUð
À / Category ¸ÁªÀiÁ£Àå ¥À.eÁ ¥À.¥ÀA II J II © III J III ©
1
SC ST II A II B III A III B
GM CAT-1

C£Àå gÁdå «« «zÁåyðUÀ¼ÀÄ Other State

gÁdåzÀ C£Àå «.« «zÁåyðUÀ¼ÀÄ Other Univ.Within
Kashmirie Immi Grants PÁ²äÃj
7.F ªÀUÀðUÀ¼À°è ¥ÀæªÉñÀ
¥ÀqÉAiÀÄ®Ä EaѸÀÄ«gÁ?

Horanadu-Gadinadu Kannadiga
gÀPÀëuÁ ¹§âA¢
J£ï.¹.¹/¸ËÌmïì & UÉÊqïì
Are you claiming

ºÉÆgÀ£ÁqÀÄ/UÀr£ÁqÀÄ PÀ£ßÀ rUÀ

ªÀiÁf ¸ÉʤPÀgÀÄ Ex servicemen
NCC/Scouts& Guides

°AUÀvÀé C®à ¸ÀASÁåvgÀ ÀÄ

J£ï. J¸ï. J¸ï.
admission under any
Differently-abled

State students

Transgender
of the Quota shown?

QæÃqÉ
«PÀ®ZÉÃvÀ£À

Students
NSS

Defence personnel
Sports

¤gÁ²æ vÀgÀÄ

Univ.
C¨sÀåyðUÀ¼ÄÀ ¥À.eÁ/¥À.¥ÀA/EvÀgÉ »AzÀĽzÀ ªÀUÀðPÉÌ ¸ÉÃjzÀªÀgÁVzÀÝ°è ¸ÀA§A¢ü¹zÀ C¢üPÁjUÀ½AzÀ ¥Àqz
É À ¥ÀæªÀiÁt ¥ÀvÀæ ®UÀwÛ¸ÀĪÀÅzÀÄ
If Candidate belongs to SC/ST /OBC, enclose the Caste Certificate issued by the Competent Authority
8. C¨såÀ yðAiÀÄÄ 371(J) C£ÀéAiÀÄ «ÄøÀ¯ÁwUÉ CºÀðvÉ ¥ÀqÉ¢gÀÄvÁÛ£ÉAiÉÄÃ? ºËzÀÄ: C®è
Candidates belongs to 371(J) Yes : No
9 (b) Aadhar Number
9 (a) vÀAzÉ/¥ÉÇõÀPÀgÀ GzÉÆåÃUÀ ªÀÄvÀÄÛ ªÁ¶ðPÀ DzÁAiÀÄ DzsÁgï ¸ÀASÉå

Father’s/ Guardian’s Occupation & Annual Income

10.¸ÀA¥ÀQð¸À¨ÉÃPÁzÀ «¼Á¸À ..............................................................................................................

F- ªÉÄÃ¯ï ¸À»vÀ ..............................................................................................................
Address for
..............................................................................................................
Communication With
E- Mail ID ................................................Pin code.................................................
Ph:..................................E-mail..............................................................
11.F »AzÉ C¨sÀå¹¹zÀ ªÀĺÁ«zÁå®AiÀÄ ªÀÄvÀÄÛ «.« ºÉ¸ÀgÀÄ
Name of the College & University last Studied

12.CºÀðvÁ ¥ÀjÃPÉëAiÀÄ ºÉ¸ÀgÀÄ Details of Qualifying Examination

PÀæ.¸ÀA Register wAUÀ¼ÀÄ ªÀÄvÀÄÛ
¥ÀjÃPÉë «±Àé«zÁå®AiÀÄ Number
UÀjµÀ× CAPÀUÀ¼ÀÄ ¥ÀqÉzÀ CAPÀUÀ¼ÀÄ ¥Àæw±ÀvÀ µÀgÁ
Sl. ªÀµÀð Month Remarks
No. Examination University £ÉÆÃAzÀt ¸ÀASÉå Max. Marks Marks Obtained Percentage
& Year
 13.CºÀðvÁ ¥ÀjÃPÉëAiÀÄ ºÉ¸g
À ÀÄ (ªÀÄÆ® ¨sÁµÁ «µÀAiÀÄUÀ¼£
À ÀÄß ºÉÆgÀvÀÄ ¥Àr¹ LaÑPÀ «µÀAiÀÄUÀ¼À CAPÀUÀ¼£
À ÀÄß ªÀiÁvÀæ ¥ÀjUÀt¹)
Details of the marks obtained in all the optional subjects in qualifying Degree Examination
Sl. Sem I / Sem II Sem III Sem IV Sem V Sem VI Total % of
No. SUBJECT Year /Year /Year /Year /Year /Year Marks Marks
MO MM MO MM MO MM MO MM MO MM MO MM MO MM
1

MO: Indicates Marks Obtained in the concerned subject / paper

along with theory/ Practicals (wherever applicable ) Aggregate Percentage of
MM: Indicates Maximum Marks for the concerned subject / Marks of all the Semesters:
paper
along with theory/ Practicals (wherever applicable )

14. 14. ¸ÀéAiÀÄA CªÀ®A©vÀ AiÉÆÃd£É ±ÀÄ®ÌzÀr ¥ÀæªÉñÀ§AiÀĸÀÄ«gÁ? ºËzÀÄ/Yes E®è/No

Would you like to be considered under Self Supporting Scheme

15. £É¥sïÖ/ZÀ®£ï «ªÀgÀ ªÉÆvÀÛ gÀÆ. ________________________ AiÀÄÄnDgï: ________________________ .¢£ÁAPÀ: _________________
NEFT Details Amount Rs:……………………….. UTR No: …………………………….. Date. ………………………..

Name of the Drawee Bank: CANARA BANK, VSK UNIVERSITY CAMPUS BRANCH, BALLARI

Name of the Account holder: Finance Officer

A/C No:3866101000001 IFSC Code: CNRB0003866

C¨sÀåyðAiÀÄ WÉÆõÀuÉ /DECLARATION BY THE CANDIDATE

£Á£ÀÄ F PÉÆùð£À eÉÆvÉUÉ ¨ÉÃgÉ AiÀiÁªÀÅzÉà gÉUÄÀ å®gï ¥Àz« À PÉÆùðUÉ F «±Àé«zÁå®AiÀÄzÀ¯ÁèUÀ°Ã CxÀªÁ
C£Àå ¸ÀA¸ÉÜUÀ¼¯
À ÁèUÀ°Ã ¥ÀæªÃÉ ±À ¥ÀqÉ¢gÀĪÀ¢®èªÉAzÀÄ ºÁUÀÆ F CfðAiÀÄ°è £ÀªÄÀ Æ¢¹zÀ ªÀiÁ»w ªÀÄvÀÄÛ
CqÀPÀUÆÉ ½¹zÀ zÁR¯ÉU¼ À ÀÄ ¸ÀvÀå«gÀÄvÀÛªÉAzÀÄ ¥ÀæªiÀ ÁtÂÃPÀj¸ÀÄwÛzÉÝãÉ. AiÀÄÄf¹/¥ÀæªÃÉ ±À ¤AiÀĪÀÄUÀ¼À ¥ÀæPÁgÀ ¥Àæw
«µÀAiÀÄzÀ ¥ÀjÃPÉëUÉ ºÁdgÁUÀ®Ä PÀ¤µÀÖ 75% ºÁdgÁw (80% ²PÀët/zÉÊ»PÀ ²PÀët «¨sÁUÀ) PÀqÁØAiÀÄ ªÀÄvÀÄÛ
ºÁdgÁwAiÀÄ PÉÆgÀvÉUÉ jAiÀiÁ¬Äw ¤ÃqÀ®Ä ¤AiÀĪÀÄUÀ¼° À è CªÀPÁ±À«®è JA§ÄzÀPÉÌ £Á£ÀÄ §zÀÝ£ÁVgÀÄvÉÛãÉ.
£Á£ÀÄ «±Àé«zÁå®AiÀÄzÀ ¤AiÀĪÀÄUÀ½UÉ §zÀÝ£ÁVzÉÝãÉ.

I shall hereby solemnly affirm that, I am not pursuing simultaneously any other regular Degree
in the University or outside the University. Further I state that the statements made and
information furnished by me in this application and in the enclosure are true to the best of my
knowledge. I shall hereby declare to fulfil 75% of attendance in each subject / paper (80% in
case of M.Ed/M.P.Ed) to appear for the examinations as per University norms and admission
Regulations. I also know that there is no provision in the University rules to condone the
shortage of attendance.

¸ÀܼÀ / Place :

¢£ÁAPÀ / Date : C¨sÀåyðAiÀÄ gÀÄdÄ/ Signature of the Applicant

 FOR OFFICE USE ONLY / PÁ0iÀiÁð®0iÀÄzÀ G¥À0iÉÆÃUÀPÁÌV ªÀiÁvÀæ

Cfð ¸ÀA, Application No.

Received by : ____________________________________ Date:

¥ÀqÉzÀªÀgÀ ºÉ¸ÀgÀÄ ªÀÄvÀÄÛ ¸À» (Name and Signature) ¢£ÁAPÀ :

Scrutinized by : _________________________________ Date :

¥ÀjÃQë¸À®àlÖªÀgÀ ºÉ¸ÀgÀÄ ªÀÄvÀÄÛ ¸À» (Name and Signature ) ¢£ÁAPÀ :

Remarks /μÀgÁ :

ªÀÄÄRå¸ÀÜgÀ ¸À» /Signature of the Chairman

2019-20£Éà ¸Á°UÉ ¸ÁßvÀPÆ

É ÃvÀg
Û À ¥ÀæªÉñÀPÉÌ _________________________ gÀªÀjAzÀ CfðAiÀÄ£ÀÄß

¢£ÁAPÀ: __________________ ¥ÀqÉAiÀįÁVzÉ.

Cfð
«µÀAiÀÄ
¸ÀASÉå

«.«.ªÀÄÄzÉæ Cfð ¥ÀqÉzÀªÀgÀ ¸À»